Why Constipation Develops

There are many factors that may contribute to constipation. Some of these factors may include: 

  • Poor fluid intake
  • Low fiber intake
  • High intake of constipating foods such as white refined carbohydrates, certain fruits/vegetables (e.g. infant bananas and carrots) and dairy products. It is not uncommon for babies to get constipated when they start to change from breast milk to formula or start baby foods.
  • Difficulty with positioning to have an effective bowel evacuation. This can be particularly true in children with motor disability but all young children may have difficulty positioning themselves on a large toilet. For these children, a child’s toilet, step stool or foot rest will be very helpful. For children with developmental disabilities, a physical therapist can help the parent select equipment that will provide for optimal positioning.
  • Ignoring urges to have a bowel movement (e.g. when a child is busy playing or during school). Toilet training can create a situation that leads to constipation since children are learning to “hold their BM” till an appropriate time (on the toilet). This may be particularly true in the child who is afraid of the toilet or just not ready for toilet training. Sometimes they may hold the BM till it becomes more solid and difficult to pass. This may lead to pain and subsequently they are afraid to poop. Children who are very busy may not have time to poop; these children will be helped by allowing time for toilet sitting about 10-20 minutes after a meal once a day when they are likely to feel the urge to need to poop. Some children may have a short attention span so they don’t stay on the toilet long enough to have a BM. The parent can help the child by giving them activities or reading to them to help them stay on the toilet a little longer. Some children may ignore the urge to have a BM because they do not like the sensation of having a BM. This may be particularly true of children with sensory integration disorder or autism. Children may also avoid having BMs in public places such as at school. These children need to have a bowel sitting program so they have schedule time to go to the bathroom either after breakfast or dinner when they are home.
  • Withholding stool due to past painful bowel movements
  • Perhaps an underlying biological tendency toward constipation
  • Most children with constipation do not have an underlying medical problem (such as low thyroid or a bowel anatomic abnormality) however if a child has persistent problems with constipation, it is important for a health care provider to carefully consider any possible underlying problem. Most problems can be excluded by a history and physical exam. Special tests are ordered only if there are concerns from the child’s history or exam that suggest an underlying medical problem.

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Resources:

National Institute of Diabetes and Digestive and Kidney Diseases 
http://digestive.niddk.nih.gov/ddiseases/pubs/constipationchild/

The American Academy of Pediatrics
www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Constipation.aspx

North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)
www.naspghan.org/wmspage.cfm?parm1=493